近视儿童眼调节功能的客观检查与分析

Objective examination and analysis of eye accommodation function of children with myopia

目的对假性近视和真性近视儿童注视近距与远距视标时的调节功能进行客观检查分析,探讨眼调节功能与近视发生发展的关系。方法选取2021年4月济南市某小学眼健康筛查中符合纳入标准的105例(105眼)学龄期儿童为研究对象,根据睫状肌麻痹验光结果分为正视眼组(40例)、假性近视组(33例)、真性近视组(32例)。首先所有受试者检测主观调节反应(BCC)与正/负相对调节(PRA/NRA),然后应用近远调节功能检测系统测量受试者在注视近点25 cm处与远点250 cm处时眼客观调节反应(AR)、调节微波动(AM)与调节滞后(AL),最后所有受试者进行睫状肌麻痹验光。结果3组受试者BCC、NRA差异均无统计学意义(均为P>0.05)。3组受试者PRA差异有统计学意义(P<0.05)。两两比较结果显示,正视眼组与真性近视组、假性近视组与真性近视组受试者PRA比较,差异均有统计学意义(均为P<0.05),正视眼组与假性近视组受试者PRA差异无统计学意义(P>0.05)。在近点25 cm处,3组受试者AR值差异有统计学意义(P<0.001)。两两比较结果显示,正视眼组受试者AR值显著高于假性近视组和真性近视组,差异均有统计学意义(均为P<0.001),而假性近视组受试者与真性近视组患者AR值差异无统计学意义(P>0.05)。3组受试者AM值差异有统计学意义(P<0.05)。两两比较结果显示,假性近视组受试者AM值显著高于正视眼组,差异有统计学意义(P<0.05),其余组间比较差异均无统计学意义(均为P>0.05)。3组受试者AL值差异有统计学意义(P<0.001)。两两比较结果显示,正视眼组受试者AL值显著低于假性近视组与真性近视组,差异均有统计学意义(均为P<0.001),而假性近视组受试者与真性近视组患者AL值差异无统计学意义(P>0.05)。而在远点250 cm处,3组受试者AR值、AM值、AL值差异均无统计学意义(均为P>0.05)。3组受试者在近点25 cm处AR值、AM值、AL值均显著大于远点250 cm处,差异均有统计学意义(均为P<0.001)。结论调节功能异常是引起学龄期儿童假性近视的主要因素,调节功能异常和近距离工作可能与近视的发生发展相关,改善调节功能是近视早期控制的关键。

Objective To objectively analyze the eye accommodation function of children with pseudomyopia or true myopia when gazing at the visual targets at near and far viewing distances and explore the relationship between eye accommodation function and the occurrence and development of myopia.Methods A total of 105 school-age children(105 eyes)who met the inclusion criteria were selected based on an eye health screening at a primary school in Jinan in April 2021.According to the optometry results of cycloplegia,they were divided into the emmetropia group(40 eyes),pseudomyopia group(33 eyes)and true myopia group(32 eyes).The subjective accommodative response(binocular cross-cylinder,BCC)and positive/negative relative accommodation(PRA/NRA)were examined.Then,the accommodation response(AR),accommodative micro-fluctuation(AM)and accommodative lag(AL)were measured by the accommodation function detection system at the near point of 25 cm and the far point of 250 cm.Finally,all the subjects underwent cycloplegic optometry.Results There was no significant difference in BCC and NRA among the three groups(both P>0.05).The difference in PRA was statistically significant among the three groups(P<0.05);the pairwise comparison results showed that there was a significant difference in PRA between the emmetropia group and true myopia group,pseudomyopia group and true myopia group(both P<0.05),but no significant difference between the emmetropia group and pseudomyopia group(P>0.05).At the near point of 25 cm,the difference in AR was statistically significant among the three groups(P<0.001);the pairwise comparison results showed that the AR of the emmetropia group was significantly higher than that of the pseudomyopia group and the true myopia group(both P<0.001),but there was no significant difference between the pseudomyopia group and true myopia group(P>0.05).The difference in AM was statistically significant among the three groups(P<0.05);the pairwise comparison results showed that the AM of the emmetropia group was significantly lower than that of the pseudomyopia group(P<0.05),but there was no significant difference in other pairwise comparisons(both P>0.05).The difference in AL was statistically significant among the three groups(P<0.001);the pairwise comparison results demonstrated that the AL of the emmetropia group was significantly lower than that of the pseudomyopia group and the true myopia group(both P<0.001),but no significant difference was found between the pseudomyopia group and the true myopia group(P>0.05).At the far point of 250 cm,there was no significant difference in AR,AM and AL among the three groups(all P>0.05).Among the three groups,the AR,AM and AL at the near point of 25 cm were significantly higher than those at the far point of 250 cm(all P<0.001).Conclusion Abnormal eye accommodation is the main factor that causes pseudomyopia in school-aged children.Abnormal eye accommodative function and short-distance work may be related to the occurrence and development of myopia,so the improvement of eye accommodation is the key to early control of myopia.